- Molina Healthcare (San Antonio, TX)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …services through an interdisciplinary team that includes the PCP, RN Care Manager, LVN , clerical associate as well as other clinical services necessary to meet the ... more mid-level providers. Physicians are expected to provide clinical oversight and review the care provided by mid-level practitioners. Most providers will need to… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …services through an interdisciplinary team that includes the PCP, RN care manager, LVN , clerical associate as well as other clinical services necessary to meet the ... one or more mid-level providers and expected to provide clinical oversight and review the care provided by mid-level practitioners. Most providers will need to act… more
- Molina Healthcare (San Antonio, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
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